Active NPI
Michelle Fogg, PT
- Physical Therapist
- Lake Oswego, OR
National Provider Identifier
1083019863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6204
- Practice address
- 4500 Kruse Way Suite 310
Lake Oswego, OR 97035 - Phone
- (503) 620-3407
- NPI assigned
- Oct 23, 2014
- Last updated
- Oct 23, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 6204 | OR | Primary |
Addresses
Primary practice location
4500 Kruse Way Suite 310
Lake Oswego, OR 97035
Mailing address
8546 SW 160TH Ave
Beaverton, OR 97007
Phone (503) 330-8751
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414022400000",
"number": "1083019863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8546 SW 160TH AVE",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "97007",
"telephone_number": "503-330-8751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 KRUSE WAY SUITE 310",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "97035",
"telephone_number": "503-620-3407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOGG",
"first_name": "MICHELLE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-10-23",
"last_updated": "2014-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "6204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Oswego, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.